Going gluten-free

People with celiac disease need to eat a gluten-free diet, but why are other consumers joining them?

The Hannaford store in Portland Maine recently expanded its Nature Place department –which used to include but a few shelves of gluten-free products– to a 40-foot area stocked with more than 500 items ranging from cookies to pasta sauce, all of them free of the protein that can pose real problems for people with celiac disease.

Oddly enough, the celiac disease population—the people who genuinely need gluten-free food—seem to have little to do with the current boom in gluten-free products.

A recent survey reports that 15 to 25 percent of consumers are looking for gluten-free choices when they shop for food. The same survey reveals that only 1 percent of those shoppers actually have celiac disease—a permanent sensitivity to gluten, a protein found in wheat, rye, barley and some contaminated oats. The effects range from diarrhea and constipation to profound developmental problems like failure to start puberty at the normal time. In contrast to the wide range of symptoms, there’s only one treatment—removing gluten from the diet completely. So why would anyone choose the expense and inconvenience of a gluten-free lifestyle unless they absolutely had to?

Anecdotally, stories are being shared online of children and adults who have credited a gluten-free diet for improvements in everything from infertility and ADHD to helping clear up severe acne or depression. NBC Los Angeles reported on one family who believed that a gluten-free diet had resulted in improvements in their daughter’s autism.

But Alan Leichtner, MD, senior associate in medicine in Children’s Hospital Boston’s Division of Gastroenterology and Nutrition, is quick to refute these tenuous connections, worrying that the public’s fascination with “going gluten-free” could lead to inappropriate self-diagnosis. “There are no studies showing that the gluten-free diet has an impact on anything other than celiac disease,” he says. “The medical data simply aren’t there.”

Children’s Clinical Nutrition Specialist Karen Warman, MS, RD, LDN, concurs. Having instant information at their fingertips can lead some parents to overconfidence about their understanding of the gluten-free diet. “The information on the Internet, depending on the website, may or may not be accurate,” says Warman.

Some conditions people are attempting to treat through the elimination of gluten—such as acne or ADHD—may even be underlying symptoms of celiac disease itself. Gluten causes digestive problems that create inflammation in the abdomen and can result in acne and behavioral disturbances—such as mood swings and irritability—that may be mistaken for ADHD. In children with true gluten sensitivity, simply removing gluten from the diet may resolve these symptoms.

Alan Leichtner, MD, MPH

Another misconception is that gluten-free is synonymous with healthy, as many people automatically associate the word “free” with something unhealthy being removed from their diet. “Many prepackaged foods may be gluten-free,” says Warman. “That doesn’t mean they’re nutritionally complete.” Some gluten-free alternatives can be just as high in fat and sugar—or just as lacking in fiber—as their gluten-containing counterparts. Shoppers buying gluten-free products solely for the perceived health benefits may find that they’re still getting the things they should be cutting out of their diets while losing many of the nutrients they actually need. Many grains are supplemented with B vitamins, which need to be replaced in the diets of people who are on a gluten-free diet. “People who do this as a fad diet may not be paying attention to their nutrition,” says Leichtner.

Leichtner does see a positive side, however. The greater the public demand for gluten-free products, the more incentive retailers have to stock them and the easier—and less expensive—it will be for those with celiac disease to get the foods they need. Last year, for example, Starbucks started selling gluten-free pastries and Uno Chicago Grill unveiled an entire line of gluten-free pizzas—kid-friendly favorites that are usually off limits for kids with celiac disease.

This national embracing of gluten-free choices is well-timed. Leichtner confirms that the number of kids Children’s is diagnosing each year with celiac disease has tripled in the last five years. One reason is increased awareness of celiac disease, but a study that tracked the disease over 50 years showed a definite increase in prevalence. And parents of children with celiac disease are making their voices heard: Children’s Celiac Support Group has more than 400 member families, making it one of the largest such groups in the country.

Despite the benefits of increased awareness, the trend towards people going gluten-free for reasons unconnected to celiac disease concerns Leichtner. “The irony is that people with celiac disease would likely never choose to go on a gluten-free diet, unless it was medically indicated,” he says. “And here you have perfectly healthy people going gluten-free just because they think gluten is bad for them.”